Individual
DR. JEFFREY JOSEPH BONGIORNO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1317 W GRAND AVE, PORT WASHINGTON, WI 53074-2075
(262) 284-8800
(262) 284-8861
Mailing address
2132 WILLOW POND WAY, GRAFTON, WI 53024-9102
(262) 268-1789
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
798025
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41755100
—
WI
05
—
43227800
—
WI
01
—
4998210001
DMERC
—
01
—
P00085509
RR MCR
—
Enumeration date
07/31/2006
Last updated
11/19/2007
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